Supplemental Condensed Consolidating Statements of Cash flows (Detail) (USD $) In Thousands, unless otherwise specified	12 Months Ended
Dec. 31, 2014	Dec. 31, 2013	Dec. 31, 2012
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	$ 1,035,876	$ 884,241	$ 799,231
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(391,150)	(358,493)	(363,192)
Acquisition of property and businesses	(431,386)	(12,636)	(527,847)
Proceeds received from sale of assets and businesses	15,178	37,482	149,311
Costs incurred for purchase and development of electronic health records application	(13,488)	(49,811)	(54,362)
Increase in insurance subsidiary investments	(12,000)	0	0
Return of Deposit on terminated purchase agreement	0	0	6,500
Net cash provided by (used in) investing activities	(832,846)	(383,458)	(789,590)
Cash Flows from Financing Activities:
Reduction of long-term debt	(879,129)us-gaap_RepaymentsOfLongTermDebt	(440,224)us-gaap_RepaymentsOfLongTermDebt	(849,647)us-gaap_RepaymentsOfLongTermDebt
Additional borrowings	830,000us-gaap_ProceedsFromLinesOfCredit	15,761us-gaap_ProceedsFromLinesOfCredit	913,500us-gaap_ProceedsFromLinesOfCredit
Financing costs	(14,976)us-gaap_PaymentsOfFinancingCosts	(231)us-gaap_PaymentsOfFinancingCosts	(8,283)us-gaap_PaymentsOfFinancingCosts
Repurchase of common shares	(100,749)	(27,201)	(19,154)
Dividends paid	(29,665)us-gaap_PaymentsOfDividends	(19,621)us-gaap_PaymentsOfDividends	(58,395)us-gaap_PaymentsOfDividends
Issuance of common stock	6,863	5,708	5,435
Excess income tax benefits related to stock based compensation	33,912	20,121	16,040
Profit distributions to noncontrolling interests	(33,680)	(61,329)	(26,895)
Changes in intercompany balances with affiliates, net	0	0	0
Net cash (used in) provided by financing activities	(187,424)	(507,016)	(27,399)
Effect of exchange rate changes on cash and cash equivalents	(775)	0	0
Decrease in cash and cash equivalents	14,831	(6,233)	(17,758)
Cash and cash equivalents, beginning of period	17,238	23,471	41,229
Cash and cash equivalents, end of period	32,069	17,238	23,471
Consolidating Adjustments
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	0	0	0
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	0	0	0
Acquisition of property and businesses	0	0	0
Proceeds received from sale of assets and businesses	0	0	0
Costs incurred for purchase and development of electronic health records application	0	0	0
Increase in insurance subsidiary investments	0
Return of Deposit on terminated purchase agreement			0
Net cash provided by (used in) investing activities	0	0	0
Cash Flows from Financing Activities:
Reduction of long-term debt	0	0	1,613
Additional borrowings	0	0	(1,613)
Financing costs	0	0	0
Repurchase of common shares	0	0	0
Dividends paid	0	0	0
Issuance of common stock	0	0	0
Excess income tax benefits related to stock based compensation	0	0	0
Profit distributions to noncontrolling interests	0	0	0
Changes in intercompany balances with affiliates, net	0	0	0
Net cash (used in) provided by financing activities	0	0	0
Effect of exchange rate changes on cash and cash equivalents	0
Decrease in cash and cash equivalents	0	0	0
Cash and cash equivalents, beginning of period	0	0	0
Cash and cash equivalents, end of period	0	0	0
Parent
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	18,579	17,946	(37,648)
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	0	0	0
Acquisition of property and businesses	0	0	0
Proceeds received from sale of assets and businesses	0	0	0
Costs incurred for purchase and development of electronic health records application	0	0	0
Increase in insurance subsidiary investments	0
Return of Deposit on terminated purchase agreement			6,500
Net cash provided by (used in) investing activities	0	0	6,500
Cash Flows from Financing Activities:
Reduction of long-term debt	(866,748)	(429,996)	(843,002)
Additional borrowings	830,000	15,761	913,500
Financing costs	(14,976)	(231)	(8,283)
Repurchase of common shares	(100,749)	(27,201)	(19,154)
Dividends paid	(29,665)	(19,621)	(58,395)
Issuance of common stock	6,863	5,708	5,435
Excess income tax benefits related to stock based compensation	33,912	20,121	16,040
Profit distributions to noncontrolling interests	0	0	0
Changes in intercompany balances with affiliates, net	122,784	417,513	25,007
Net cash (used in) provided by financing activities	(18,579)	(17,946)	31,148
Effect of exchange rate changes on cash and cash equivalents	0
Decrease in cash and cash equivalents	0	0	0
Cash and cash equivalents, beginning of period	0	0	0
Cash and cash equivalents, end of period	0	0	0
Guarantors
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	687,101	587,083	594,606
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(230,102)	(269,419)	(312,190)
Acquisition of property and businesses	(422,081)	(8,094)	(513,596)
Proceeds received from sale of assets and businesses	11,450	7,916	142,667
Costs incurred for purchase and development of electronic health records application	(13,488)	(49,811)	(54,362)
Increase in insurance subsidiary investments	(12,000)
Return of Deposit on terminated purchase agreement			0
Net cash provided by (used in) investing activities	(666,221)	(319,408)	(737,481)
Cash Flows from Financing Activities:
Reduction of long-term debt	(867)	(109)	0
Additional borrowings	0	0	1,613
Financing costs	0	0	0
Repurchase of common shares	0	0	0
Dividends paid	0	0	0
Issuance of common stock	0	0	0
Excess income tax benefits related to stock based compensation	0	0	0
Profit distributions to noncontrolling interests	0	0	0
Changes in intercompany balances with affiliates, net	(5,444)	(271,525)	119,990
Net cash (used in) provided by financing activities	(6,311)	(271,634)	121,603
Effect of exchange rate changes on cash and cash equivalents	(775)
Decrease in cash and cash equivalents	13,794	(3,959)	(21,272)
Cash and cash equivalents, beginning of period	7,990	11,949	33,221
Cash and cash equivalents, end of period	21,784	7,990	11,949
Non Guarantors
Condensed Financial Statements, Captions [Line Items]
Net cash (used in) provided by operating activities	330,196	279,212	242,273
Cash Flows from Investing Activities:
Property and equipment additions, net of disposals	(161,048)	(89,074)	(51,002)
Acquisition of property and businesses	(9,305)	(4,542)	(14,251)
Proceeds received from sale of assets and businesses	3,728	29,566	6,644
Costs incurred for purchase and development of electronic health records application	0	0	0
Increase in insurance subsidiary investments	0
Return of Deposit on terminated purchase agreement			0
Net cash provided by (used in) investing activities	(166,625)	(64,050)	(58,609)
Cash Flows from Financing Activities:
Reduction of long-term debt	(11,514)	(10,119)	(8,258)
Additional borrowings	0	0	0
Financing costs	0	0	0
Repurchase of common shares	0	0	0
Dividends paid	0	0	0
Issuance of common stock	0	0	0
Excess income tax benefits related to stock based compensation	0	0	0
Profit distributions to noncontrolling interests	(33,680)	(61,329)	(26,895)
Changes in intercompany balances with affiliates, net	(117,340)	(145,988)	(144,997)
Net cash (used in) provided by financing activities	(162,534)	(217,436)	(180,150)
Effect of exchange rate changes on cash and cash equivalents	0
Decrease in cash and cash equivalents	1,037	(2,274)	3,514
Cash and cash equivalents, beginning of period	9,248	11,522	8,008
Cash and cash equivalents, end of period	$ 10,285	$ 9,248	$ 11,522

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Amount of currency on hand as well as demand deposits with banks or financial institutions. Includes other kinds of accounts that have the general characteristics of demand deposits. Also includes short-term, highly liquid investments that are both readily convertible to known amounts of cash and so near their maturity that they present insignificant risk of changes in value because of changes in interest rates. Excludes cash and cash equivalents within disposal group and discontinued operation.

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Amount of increase (decrease) from the effect of exchange rate changes on cash and cash equivalent balances held in foreign currencies.

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Amount of cash inflow from realized tax benefit related to deductible compensation cost reported on the entity's tax return for equity instruments in excess of the compensation cost for those instruments recognized for financial reporting purposes.

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The net cash inflow or outflow for the increase (decrease) associated with funds that are not available for withdrawal or use (such as funds held in escrow) and are associated with underlying transactions that are classified as investing activities.

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The net cash outflow or inflow from other investing activities. This element is used when there is not a more specific and appropriate element in the taxonomy.

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Amount of cash outflow in the form of ordinary dividends provided by the non-wholly owned subsidiary to noncontrolling interests.

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The cash outflow for loan and debt issuance costs.

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The cash inflow from the additional capital contribution to the entity.

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Amount of cash inflow from contractual arrangement with the lender, including but not limited to, letter of credit, standby letter of credit and revolving credit arrangements.

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The cash inflow from the sale of property, plant and equipment (capital expenditures), software, and other intangible assets.

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The cash outflow for debt initially having maturity due after one year or beyond the normal operating cycle, if longer.

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